Marital Relationship and Quality of Life in Couples Following Hip Replacement Surgery.

For the majority of patients with osteoarthritis, total hip (THA) arthroplasty results in a significant reduction in pain, emotional distress, and disability and a significant improvement in their quality of life. Little is known about how these recovery-related changes impact the spouse or the marital relationship. METHODS: Twenty-nine couples whose spouse underwent a THA (29 THA) participated in a semi-structured retrospective interview designed for this study. They were each asked to recall the level of pain before and after surgery and to provide a numerical rating score for questions pertaining to the level of disability in seven different activities of daily living. Couples were also asked to list in order of importance the five ways in which the surgery affected their overall quality of life. RESULTS: The spouses estimated their partner's pain, both pre- and postoperatively, to be significantly higher level than the patient's perception. The spouses perceived a greater improvement in family/home responsibilities, recreation and social activities, and in their occupation than that noted by the partner. After the arthroplasty, the spouses indicated that their lives had improved with respect to doing more activities/leisure (72%), because their partner had less suffering (59%), they had more independence/less caregiving (55%), it improved their marital relationship (52%), they had a better social/family life (28%), and they were able to travel (28%). CONCLUSIONS: This study indicates that THA result in a significant improvement in quality of life not only for the patients, but also for their spouses.

Predicting the Physical and Mental Health Status of Individuals With Chronic Musculoskeletal Pain From a Biopsychosocial Perspective: A Multivariate Approach.

OBJECTIVES: Chronic pain is theoretically conceptualized from a biopsychosocial perspective. However, research into chronic pain still tends to focus on isolated, biological, psychological, or social variables. Simultaneous examination of these variables in the prediction of outcomes is important because communalities between predictors exist. Examination of unique contributions might help guide research and interventions in a more effective way. METHODS: The participants were 114 individuals with chronic pain (mean age=58.81, SD=11.85; 58.8% women and 41.2% men) who responded to demographics (age and sex), pain characteristics (duration and sensory qualities), psychological (catastrophizing and perceived injustice), and social (marital adjustment) measures. Multivariate analyses were conducted to investigate their unique contributions to pain-related health variables pain severity, pain interference, disability, anxiety, and depressive symptoms. RESULTS: Bivariate analyses evidenced significant associations between pain sensory qualities, catastrophizing, perceived injustice, and all health variables. In multivariate analyses, pain sensory qualities were associated with pain severity (ß=0.10; 95% confidence interval [CI]=0.05, 0.14; t=4.28, P<0.001), while perceived injustice was associated with pain interference (ß=0.08; 95% CI=0.03, 0.12; t=3.59, P<0.001), disability (ß=0.25; 95% CI=0.08, 0.42; t=2.92, P=0.004), anxiety (ß=0.18; 95% CI=0.08, 0.27; t=3.65, P<0.001), and depressive symptoms (ß=0.14; 95% CI=0.05, 0.23; t=2.92, P=0.004). Age, sex, pain duration, and marital adjustment were not associated with health variables either in bivariate or in multivariate analyses (all P>0.010). DISCUSSION: As expected, communalities between biopsychosocial variables exist, which resulted in a reduced number of unique contributions in multivariate analyses. Perceived injustice emerged as a unique contributor to variables, which points to this psychological construct as a potentially important therapeutic target in multidisciplinary treatment of pain.

The impact of chronic pain on patients and spouses: Consequences on occupational status, distribution of household chores and care-giving burden.

BACKGROUND: Informal care-giving by spouses has become frequent in chronic pain settings. However, the impact of pain on occupational, functional and health outcomes in spouses has not been systematically investigated. AIMS: The goal of the present study was to examine the impact of pain on both patient and spousal outcomes. METHODS: In the present study, the impact of chronic pain on 114 heterosexual dyads was explored (patients: 59% females, average age = 57.81 years, SD = 11.85; spouses: 41% females, average age = 57.32 years, SD = 12.15). RESULTS: Overall, both patients and spouses reported important consequences of pain on outcomes, including occupational status distribution of household chores and marital satisfaction). Almost 52% of spouses indicated a high-to-severe burden. A multivariate model with spouse and patient factors accounted for 37.8% of the variance of this burden. In the model, patient disability (ß = 0.36, p = .002), spouses' change in occupational status (ß = 0.26, p = .002) and spousal perception of marital adjustment (ß = -0.36, p < .001) were uniquely associated with burden. CONCLUSIONS: The results indicate that the impact of chronic pain should be evaluated both for patients and spouses and point to patient and spouse factors that might contribute to spousal burden, which might help guide family interventions in a more effective manner. SIGNIFICANCE: Research has shown that chronic pain poses a significant burden on individuals, which increases their reliance on others for assistance. However, the burden of informal care-giving assumed by spouses of patients with chronic pain has not been systematically investigated. This study offers new insights into the impact of chronic pain on patients and their spouses, which might provide empirical foundation for the development of new avenues for intervention aimed at promoting adjustment in patients with chronic pain and spouses who act as informal caregivers.

A Systematic Review of the Association Between Perceived Injustice and Pain-Related Outcomes in Individuals with Musculoskeletal Pain.

OBJECTIVE: A growing body of literature shows that justice-related appraisals are significant determinants of pain-related outcomes and prolonged trajectories of recovery. We conducted a systematic review of the literature assessing the relationship between perceived injustice and pain-related outcomes in individuals with musculoskeletal pain. DESIGN AND PARTICIPANTS: A search of published studies in English in PubMed, PsychInfo, Embase, and Cochrane Database of Systematic Reviews from database inception through May 2019 was performed. Search terms included "perceived injustice," "injustice appraisals," "perceptions of injustice," and "pain" or "injury." RESULTS: Thirty-one studies met inclusion criteria. Data for a total of 5,969 patients with musculoskeletal pain were extracted. Twenty-three studies (71.9%) reported on individuals with persistent pain lasting over three months, and 17 studies (53.1%) reported on individuals with injury-related musculoskeletal pain. Significant associations were found between perceived injustice and pain intensity, disability and physical function, symptoms of depression and anxiety, post-traumatic stress disorder, quality of life and well-being, and quality of life and social functioning. CONCLUSIONS: This systematic review summarizes the current evidence for the association between perceived injustice and pain-related outcomes. There is strong evidence that perceived injustice is associated with pain intensity, disability-related variables, and mental health outcomes. Implications and directions for future research are discussed.

The Relationship Between Level of Catastrophizing and Mental Health Comorbidity in Individuals With Whiplash Injuries.

OBJECTIVES: Pain catastrophizing has been shown to be correlated with measures of mental health problems such as depression and post-traumatic stress disorder (PTSD). However, the clinical implications of findings reported to date remain unclear. To date, no study has been conducted to determine meaningful cut-scores on measures of catastrophizing indicative of the heightened risk of mental health comorbidity. One objective of the present study was to identify the cut-score on the Pain Catastrophizing Scale (PCS) indicative of the heightened risk of the comorbidity of depression and PTSD. A second objective was to determine whether mental health comorbidity mediated the relationship between catastrophizing and occupational disability. MATERIALS AND METHODS: The sample consisted of 143 individuals with whiplash injuries. Pain severity, pain catastrophizing, depression, and post-traumatic stress symptoms were assessed after admission to a rehabilitation program. Mental health comorbidity was operationally defined as obtaining a score above the clinical threshold on measures of depressive and/or post-traumatic stress symptom severity. RESULTS: A receiver operating characteristic curve analysis revealed that a PCS score of 22 best distinguished between participants with and without mental health comorbidity. Results also revealed that mental health comorbidity mediated the relationship between catastrophizing and occupational disability. DISCUSSION: The findings suggest that a score of ≥22 on the PCS should alert clinicians to the possibility that patients might also be experiencing clinically significant symptoms of depression or PTSD. Greater attention to the detection and treatment of mental health conditions associated with whiplash injury might contribute to more positive recovery outcomes.

Acculturation and adjustment of migrants reporting trauma: The contextual effects of perceived ethnic density.

Little is known about the relation between acculturation and socioecological contexts of migrants with a personal trauma history living in the community. This study represents an extension of our previous work and aimed to unpack the perceived neighborhood ethnic density (ED) effect and examine the moderating role of ED on the acculturation-adjustment relation in a community sample of migrants with trauma (N = 99) from developing countries residing in Montreal, Canada. ED was protective against general psychological distress but did not predict posttraumatic symptoms. The ED effect was mediated via degree of acculturation to the French-Canadian mainstream cultural context, rather than heritage acculturation, social support, or discrimination. Moreover, protective effects of French-Canadian mainstream acculturation for depressive symptoms and life satisfaction were found under high but not low ED conditions. Similarities and differences with our previous research as well as theoretical and prevention implications are discussed from a person-environment interaction perspective.

Trait Perceived Injustice Is Associated With Pain Intensity and Pain Behavior in Participants Undergoing an Experimental Pain Induction Procedure.

Recent research has revealed robust cross-sectional and prospective associations among perceived injustice, pain, disability, and depressive symptoms in patients with chronic pain. To date, research has proceeded from the assumption that perceived injustice arises as a consequence of debilitating injury or illness. However, it is possible that perceived injustice might have trait-like characteristics, persisting even in the absence of an injustice-related eliciting event. The aim of the present study was to develop and test a measure of trait perceived injustice (Trait Injustice Experience Questionnaire [T-IEQ]). The item content of the T-IEQ was drawn from the original IEQ and adapted for relevance to a noninjury context. A sample of 118 healthy undergraduates completed the T-IEQ, measures of just world belief, and trait forgiveness prior to participating in an experimental pain procedure. Pain intensity, pain behavior, and emotional responses were recorded during the painful induction. The T-IEQ had good internal consistency and test-retest reliability. The validity of the T-IEQ was supported by significant associations with measures of just world belief and trait forgiveness. The T-IEQ was also associated with pain intensity, pain behavior, and ratings of sadness and anger. Anger mediated the relation between the T-IEQ and pain outcomes. The results of the present study suggest that individuals vary in their trait-like propensity to experience negative life events as unjust and that trait perceived injustice contributes to adverse pain outcomes. PERSPECTIVE: The present findings suggest that perceived injustice might reflect an enduring tendency to experience negative life events as unjust. The findings also suggest that trait perceived injustice is associated with higher ratings of pain intensity and anger and more pronounced displays of pain behavior.

The prognostic value of pain catastrophizing in health-related quality of life judgments after Total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is a highly effective procedure that yields reductions in pain and disability associated with end stage osteoarthritis (OA) of the knee. Quality of life instruments are frequently used to gauge the outcomes of total knee arthroplasty (TKA). However, research suggests that post-TKA reductions in symptom severity may not be the sole predictors of quality of life post-TKA. The primary objective of the present study was to examine the prognostic value of catastrophic thinking in health-related quality of life (HRQoL) judgments in patients with severe OA after TKA. METHODS: In this study we used a prospective cohort design to examine the value of pain catastrophizing in predicting HRQoL 1 year after TKA. Participants with advanced OA of the knee who were scheduled for TKA were recruited at one of three hospitals in Canada. The study sample consisted of 116 individuals (71 women, 45 men) who completed study questionnaires at their pre-surgical evaluation and 1 year after surgery. Hierarchical regression analysis was used to assess the unique contribution of pre-surgical pain catastrophizing to the prediction of post-surgical HRQoL judgments. RESULTS: The results of the hierarchical regression equation revealed that the overall model was significant, F (9,106) = 8.3, p < 001, and accounted for 36.4% of the variance in the prediction of post-surgical physical component score of HRQoL. Pain catastrophizing was entered in the last step of the equation and contributed significant unique variance (ß = -.35, p < .001) to the prediction of post-surgical physical component score of HRQoL above and beyond the variance accounted for by demographic variables, co-morbid health conditions, baseline HRQoL, and post-surgical reductions in pain, joint stiffness and physical disability. CONCLUSIONS: The current findings highlight the importance of pre-surgical catastrophic cognitions in influencing HRQoL judgments after TKA. The findings suggest that psychosocial interventions designed to reduce pain catastrophizing before TKA might contribute to better quality of life outcomes following surgery.

The Impact of Perceived Injustice on Pain-related Outcomes: A Combined Model Examining the Mediating Roles of Pain Acceptance and Anger in a Chronic Pain Sample.

OBJECTIVE: Perceived injustice (PI) has been identified as an important risk factor for pain-related outcomes. To date, research has shown that pain acceptance and anger are mediators of the association between PI and pain-related outcomes. However, a combined conceptual model that addresses the interrelationships between these variables is currently lacking. Therefore, the current study aimed to examine the potential mediating roles of pain acceptance and anger on the association between PI and adverse pain-related outcomes (physical function, pain intensity, opioid use status). MATERIALS AND METHOD: This cross-sectional study used a sample of 354 patients with chronic pain being treated at a tertiary pain treatment center. Participants completed measures of PI, pain acceptance, anger, physical function, pain intensity, and opioid use status. Mediation analyses were used to examine the impact of pain acceptance and anger on the association between PI and pain-related outcomes. RESULTS: Examination of the specific indirect effects revealed that pain acceptance fully mediated the relationship between PI and physical function, as well as the relationship between PI and opioid use status. Pain acceptance emerged as a partial mediator of the relationship between PI and pain intensity. DISCUSSION: This is the first study to provide a combined conceptual model investigating the mediating roles of pain acceptance and anger on the relationship between PI and pain outcomes. On the basis of our findings, low levels of pain acceptance associated with PI may help explain the association between PI and adverse pain outcomes. Clinical and theoretical implications are discussed.

Functional Preference for Object Sounds and Voices in the Brain of Early Blind and Sighted Individuals.

Sounds activate occipital regions in early blind individuals. However, how different sound categories map onto specific regions of the occipital cortex remains a matter of debate. We used fMRI to characterize brain responses of early blind and sighted individuals to familiar object sounds, human voices, and their respective low-level control sounds. In addition, sighted participants were tested while viewing pictures of faces, objects, and phase-scrambled control pictures. In both early blind and sighted, a double dissociation was evidenced in bilateral auditory cortices between responses to voices and object sounds: Voices elicited categorical responses in bilateral superior temporal sulci, whereas object sounds elicited categorical responses along the lateral fissure bilaterally, including the primary auditory cortex and planum temporale. Outside the auditory regions, object sounds also elicited categorical responses in the left lateral and in the ventral occipitotemporal regions in both groups. These regions also showed response preference for images of objects in the sighted group, thus suggesting a functional specialization that is independent of sensory input and visual experience. Between-group comparisons revealed that, only in the blind group, categorical responses to object sounds extended more posteriorly into the occipital cortex. Functional connectivity analyses evidenced a selective increase in the functional coupling between these reorganized regions and regions of the ventral occipitotemporal cortex in the blind group. In contrast, vocal sounds did not elicit preferential responses in the occipital cortex in either group. Nevertheless, enhanced voice-selective connectivity between the left temporal voice area and the right fusiform gyrus were found in the blind group. Altogether, these findings suggest that, in the absence of developmental vision, separate auditory categories are not equipotent in driving selective auditory recruitment of occipitotemporal regions and highlight the presence of domain-selective constraints on the expression of cross-modal plasticity.

Reductions in Perceived Injustice are Associated With Reductions in Disability and Depressive Symptoms After Total Knee Arthroplasty.

INTRODUCTION: Perceptions of injustice have been associated with problematic recovery outcomes in individuals with a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice (PI), it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice. The present study examined the relative contributions of postsurgical reductions in pain severity, depressive symptoms, and disability to the prediction of reductions in perceptions of injustice. METHODS: The study sample consisted of 110 individuals (69 women and 41 men) with osteoarthritis of the knee scheduled for total knee arthroplasty (TKA). Patients completed measures of perceived injustice, depressive symptoms, pain, and disability at their presurgical evaluation, and at 1-year follow-up. RESULTS: The results revealed that reductions in depressive symptoms and disability, but not pain severity, were correlated with reductions in perceived injustice. Regression analyses revealed that reductions in disability and reductions in depressive symptoms contributed modest but significant unique variance to the prediction of postsurgical reductions in perceived injustice. DISCUSSION: The present findings are consistent with current conceptualizations of injustice appraisals that propose a central role for symptom severity and disability as determinants of perceptions of injustice in patients with persistent pain. The results suggest that the inclusion of psychosocial interventions that target depressive symptoms and perceived injustice might augment the impact of rehabilitation programs made available for individuals recovering from TKA.

Auditory motion in the sighted and blind: Early visual deprivation triggers a large-scale imbalance between auditory and "visual" brain regions.

How early blindness reorganizes the brain circuitry that supports auditory motion processing remains controversial. We used fMRI to characterize brain responses to in-depth, laterally moving, and static sounds in early blind and sighted individuals. Whole-brain univariate analyses revealed that the right posterior middle temporal gyrus and superior occipital gyrus selectively responded to both in-depth and laterally moving sounds only in the blind. These regions overlapped with regions selective for visual motion (hMT+/V5 and V3A) that were independently localized in the sighted. In the early blind, the right planum temporale showed enhanced functional connectivity with right occipito-temporal regions during auditory motion processing and a concomitant reduced functional connectivity with parietal and frontal regions. Whole-brain searchlight multivariate analyses demonstrated higher auditory motion decoding in the right posterior middle temporal gyrus in the blind compared to the sighted, while decoding accuracy was enhanced in the auditory cortex bilaterally in the sighted compared to the blind. Analyses targeting individually defined visual area hMT+/V5 however indicated that auditory motion information could be reliably decoded within this area even in the sighted group. Taken together, the present findings demonstrate that early visual deprivation triggers a large-scale imbalance between auditory and "visual" brain regions that typically support the processing of motion information.

Coping is Important for Spouses Too: Impulsive Coping Moderates the Relationship Between Spouses' Perception of the Patients' Pain Intensity and Spouses' Physical Health.

INTRODUCTION: Living with a patient with chronic pain is now known to have a negative impact on physical and mental health of the caregivers. Research indicates that adaptive coping strategies can reduce the burden that pain has on patients. Yet, it is unknown whether coping strategies can also affect the physical and mental health of the spouses of patients with chronic pain. In the present research, we investigated the role of coping strategies used by spouses of patients with pain in the relationship between the pain intensity of the patients and the physical and mental health of their spouses. METHODS: The study comprised 195 heterosexual couples. About 41% of spouses were females. RESULTS: Our results showed that being older, having a lower educational level, having a negative orientation toward problems, and using impulsive strategies to cope when in difficult situations contributed to poorer physical health of spouses. A poorer mental health status of spouses was associated with being negatively oriented toward problems, being a female, and being a caregiver of mentally distressed patient. In addition, it was found that the impulsive-careless coping strategy used by the spouses moderated the relationship between patients' pain severity and physical health of their spouses. At low levels of patients' pain intensity as rated by spouses, spouses reported similar levels of physical health irrespective of coping ratings. Conversely, at high levels of patients' pain intensity as rated by spouses, poorer physical health was reported by spouses scoring high on impulsive-careless coping. DISCUSSION: Implications for clinical practice are discussed. Our findings suggest that screening for coping strategies used by spouses of patients with pain might complement clinical interventions aimed at promoting the physical and mental health of patients and their partners.

The role of perceived injustice in the prediction of pain and function after total knee arthroplasty.

Emerging evidence suggests that the appraisal of pain and disability in terms of justice-related themes contributes to adverse pain outcomes. To date, however, research on the relation between perceived injustice and pain outcomes has focused primarily on individuals with musculoskeletal injuries. The primary aim of this study was to investigate the role of perceived injustice in the prediction of pain and disability after total knee arthroplasty (TKA). The study sample consisted of 116 individuals (71 women, 45 men) with osteoarthritis of the knee scheduled for TKA. Participants completed measures of pain severity, physical disability, perceptions of injustice, pain catastrophizing, and fear of movement before surgery, and measures of pain and disability 1 year after surgery. Prospective multivariate analyses revealed that perceived injustice contributed modest but significant unique variance to the prediction of postsurgical pain severity, beyond the variance accounted for by demographic variables, comorbid health conditions, presurgical pain severity, pain catastrophizing, and fear of movement. Pain catastrophizing contributed significant unique variance to the prediction of postsurgical disability. The current findings add to a growing body of evidence supporting the prognostic value of perceived injustice in the prediction of adverse pain outcomes. The results suggest that psychosocial interventions designed to target perceptions of injustice and pain catastrophizing before surgery might contribute to more positive recovery trajectories after TKA.